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Balmoral Care Home Requires improvement

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Inspection report

Date of Inspection: 14 July 2014
Date of Publication: 8 August 2014
Inspection Report published 08 August 2014 PDF


Inspection carried out on 14 July 2014

During a routine inspection

An adult social care inspector carried out this inspection. At the time of this inspection Balmoral was providing care and support to 67 people, some of whom had a diagnosis of dementia. We spoke with 17 people living at the home, and six visiting relatives to obtain their views of the support provided. In addition, we spoke with the home manager, the regional manager and eight members of staff about their roles and responsibilities.

We considered all the evidence against the outcomes we inspected to help answer our five key questions; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service told us they were treated respectfully by staff members and said they felt safe living in the home.

Safeguarding procedures were robust and staff understood their role in safeguarding the people they supported.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

We found risk assessments had been undertaken to identify any potential risk and the actions required to manage the risk. This meant that people were not put at unnecessary risk but also had access to choice and remained in control of decisions about their lives.

The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Three applications had been submitted which confirmed to us that relevant staff had been trained to understand when an application should be made and how to submit one. This meant that people would be safeguarded.

Our conversations with people who used the service, relatives and staff, together with observations on the day of our inspection evidenced there were enough staff on duty, however there was a significant number of vacant qualified staff hours being covered by agency nurses. People who used the service, their relatives and staff all said many agency nurses working did not know the needs of people, meaning that people who use the service did not receive consistency of care.

Is the service effective?

We found people were provided with nutritious food. Some people required specialised diets for health or personal reasons and these were provided.

People who used the service told us that food was very good and they enjoyed their meals.

During our visit, we found people were provided with the support they needed. We found staff knew people well and were aware of their individual preferences. We found staff treated people in a kind manner.

Care files we checked confirmed initial assessments had been carried out by the staff at the home before people moved into the home. This was to ensure the home was able to effectively meet the needs of the people. Specialist mobility and equipment needs had been identified in care plans where required. People who used the service and their relatives said they had been involved in writing their care plans and they reflected their current needs. Visitors confirmed they were able to see people in private and that visiting times were flexible.

Is the service caring?

We observed warm and respectful interactions between staff and people who used the service as well as some good humoured banter.

People who used the service were positive about the staff and felt they were known personally to them. Comments from people included, �Staff are wonderful,� �I like it here very much,� �Staff look after me alright. People come and help me (with personal care)� and �I get everything I need.�

One relative spoken with told us, �My family member is much calmer since they came here. I don�t worry about them now. I used to get phone calls from neighbours who found them wandering but I�m happier they are being well looked after. They are a lot better.

Is the service responsive?

Staff told us the care and support provided was flexible to the person�s needs and adjustments could be made where required. Staff said they informed the manager if they felt any change in needs was required and the support was reviewed. For example one relative told us, �My family member has a specific communication difficulty and requires sign language. They have one to one sessions weekly with somebody who can sign to them.� A person who used the service told us, �I�ve just been given a new wheelchair which I'm starting to get used to.�

On the day if the inspection people who used the service were going on a day trip to Bakewell. One person said, �I'm looking forward to going out. I like it here and I'm very hard to please because I'm very awkward.�

We observed staff making sure people had sun hats as it was a particularly hot day and that people had visited the toilet before leaving the building. The interaction between them was warm and very friendly.

There were no outstanding complaints about the service. People who used the service said if they had any worries they would take their concerns to a member of staff or to the managers�.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

People spoken with said they were invited to attend �resident and relative family night� which was held every month. One person said, �It�s a good idea, we can talk about whatever we want�

Staff had regular meetings with the manager and were kept updated about any information they needed to know about the service. This helped to maintain consistency in the running of the service and to ensure staff were aware of relevant information.

The service carried out a yearly �Quality Assurance Survey�. Feedback was sought by way of customer satisfaction surveys sent to people who used the service, their relatives and friends, staff and healthcare professionals. This showed people had the opportunity to put their views across.